Some of the best minds in the behavioral health field have registered concerns lately about “pretend recovery.” They have noticed that many programs simply are putting a “recovery” sign on their front door yet continuing to do the same things they always have done. This leads to the concern that recovery principles will not be given a fair shake at changing the way we do business because they really aren't being practiced in the first place.
Being eternal optimists, we're hoping that programs aren't pretending but perhaps just aren't clear about how to initiate a recovery services transformation. Obviously, a lot more is involved in the transformation process than changing the sign on the front door.
Before a program's structure can be addressed, important philosophic shifts must occur that result in major changes in a program's content and substance. We have described many ways of doing this in previous columns to assist you in aligning program content with recovery principles. While we've touched on a few structural issues, we think that we haven't given them the attention they deserve. They are often less obvious than content but can make a huge difference in having a successful shift to recovery content.
So what are these puzzling structural rudiments that lurk in the background, either helping or hindering our quest for transforming programs? First, let's define “structure.” In the context of this conversation, structure refers to the organizational framework upon which we build a program's content. It provides a foundation for organizing interrelated parts that can function as an orderly whole.
Thus, the question is, “What kind of structure best supports the recovery philosophy?” We could write a book on this one question, but for now let's just scrape the surface for a few answers.
The more the structure reflects recovery principles, the better it will support recovery content. Think of this from a multidimensional perspective, with an organization's principles and values being replicated in all of its functions. Has the CEO fully embraced recovery principles (which involve a different mind-set than that of the traditional CEO)? Have policies and procedures been rewritten to reflect recovery principles? Are there still separate bathrooms and break rooms for staff and people using services? Are there career ladders for all staff? Is the structure itself saturated with recovery principles?
We know that relationships are one of the most important tools for helping a person move into recovery. No surprises here. Nearly every book about helping and healing comes to this conclusion. So how can we create a structure that maximizes the impact of helping/healing relationships?
The structure needs to support the development of relationships by valuing them and allowing space and time for them to develop. For example, can staff report to their supervisors that they are engaging in activities with the person primarily for the purpose of developing relationships? Does the management information system allow staff to record time spent connecting with the person served?
Over the long haul, a program structure that reinforces time spent developing relationships will be more efficient than one that encourages rushing through encounters with people without even knowing who they are or having eye contact with them. Relationship development with people and their families must be built into an organization's policies and procedures, as well as reflected in the organization's vision and value statements.
Recovery values also need to be reflected in the relationships between all the people in the organization. Are managers and staff expected to treat each other with the same level of respect and consideration that we've trained staff to show people who use services? Does staff have a voice in organizational decision making? The healing relationship between the person and the staff cannot be sustained unless the rest of the organization emulates the same values and principles.
A recovery organization's structure needs to intentionally create continuity with service providers by minimizing staff turnover. With high turnover, the powerful impact of the relationship is lost quickly. While salary could be an issue, the most common reason people leave jobs has to do with working conditions that do not allow for the development of meaningful experiences that give staff a sense of purpose.
Most people take jobs in public behavioral health programs not because it's a lucrative field, but because they want to make a difference; they want to make a contribution. Does the structure acknowledge and reward this contribution? Does it value and support staff members' relationships with their boss and colleagues? Do they feel like they are making a difference? Does the organization appreciate and value their efforts?
Beyond the matter of continuity between the person and the staff is the matter of continuity between services and programs. If people have to change staff and programs every time their needs change, the structure is not bolstering the continuity necessary to support the recovery process. Do people have to change providers when they have a crisis or are admitted to a hospital? Do they have to change programs when they move to less restrictive levels of care? A structure that can effectively sustain continuity will significantly fortify the recovery process.